Danielle Bell, Author at .. Glow Group Health & Wellbeing

What to expect in your first session with our Paediatric Dietitians

If you have never seen a Dietitian before, we appreciate that you might have some questions about the process. We hope this guide can help you and your child start to understand what to expect when you meet us.

Before your session:

If your child is a private or Medicare client, you will be emailed our online intake form, which will prompt you to fill out some background information about your child.

If your child is an NDIS participant, you will likely be sent a link to help us gather some background information about your child, including their disability and NDIS plan details (only those that are relevant). We will not ask to access your full NDIS plan.

If you have any relevant documents, including letters from Specialists, blood test results or referrals, please bring these alone with you to help your Dietitian complete their assessment.

Session location:

If your child is a private or Medicare client, we will be meeting you in one of our clinics or online via telehealth depending on your preferences.

If your child is an NDIS participant, we can meet you in clinic, online via telehealth or at your own home, if your funding allows for this.

During the session:

The assessment session is an opportunity for the Dietitian to get to know you and your child. Topics covered may include medical and mental health history, growth and development patterns, mealtime experiences, gastrointestinal health, activity levels, sensory preferences, relationship with food, and food choices (safe foods, challenging foods etc). Your Dietitian may also arrange for a session to observe your child eat and/or drink, called a “mealtime observation”.

If at any time you or your child does not feel comfortable talking about a specific topic, please let us know and we can accommodate.

An assessment typically spans over anywhere between 1-3 sessions.

At the end of the session your Dietitian will provide you with an overview of what the next steps in the process are. This may include access to resources, planning at home activities, food or supplement based recommendations or discussing a plan for the next session.

Interventions are tailored to your child’s special interests and readiness for change, and may include:

Working with preferred foods to support nutritional adequacy
Utilising supplements if appropriate
Advocating for accommodations to your child’s environment, to help them feel more comfortable in the eating experience
Interaction with food, if this feels like a good fit for your child, such as cooking or grocery shopping tours
Coaching parents on how to support their child’s relationship with food

When starting with the Dietitian, you may feel very eager to get started on multiple strategies with your child, as you care so much about their health and wellbeing. We invite you to be gentle with how you may introduce new foods or routines to your children, as in our experience, a child’s relationship with food is very sensitive to any perceived pressure. Our Dietitians will be very happy to discuss this more with you in session and guide you through this process.

After the session:

The Dietitian may ask you to send through any information/documentation to help them complete their assessment. If your child’s’ Dietitian would like to talk to any of your children’s other health practitioners, they will be sure to obtain your consent first.

If your child is an NDIS participant, we typically create a formal assessment report after the assessment process is complete. Again, our Dietitians will discuss this option with you in case this is something you would like to opt out of.

Understanding ARFID

Avoidant-restrictive food intake disorder, commonly known as ARFID, is an eating disorder characterised by three typical presentations:

Persistent refusal to eat specific foods based on sensory characteristics of food
- Sensory challenges may look like difficulty being around different smelling foods, touching different textures or avoiding certain noises or colours of foods.
Concern about aversive consequences of eating and/or drinking
- For example, traumatic experiences such as choking, vomiting or gastrointestinal distress
A lack of interest in eating or food
- Can also include a lack of awareness of hunger cues

An individual can fit into one or more of these presentations.

Individuals living with ARFID often also experience one or more of the following:

Nutritional deficiency
Malnutrition and/or delayed growth
A reliance on nutrition supplements
Interference with psychosocial functioning, such as not being able to eat with friends or finding it difficult to eat at work

Seeking support

Behaviours associated with ARFID may act as a form of self-protection for some. However, if you’re noticing physical and emotional signs associated with ARFID are impacting your ability to participate in activities of daily living, or you would like to work on developing a more positive relationship with food, support is available.

Some pathways forward include:

Try to incorporate regular meals

Working towards eating regular meals every 3 or so hours is helpful for most people. It might need to be more frequent for young ones. Aiming to incorporate regular meals and snacks help to support appetite regulation and enhance nutritional intake.

Try to minimise pressure

Focus on trying to make mealtimes enjoyable. Don’t pressure yourself or your loved one to try new foods or a large volume of food if they are not ready. Being able to trust that we can decide what we ate, and how much we eat works wonders for reducing anxiety around mealtimes.

Share meals with others

Try to have non-preferred food around the table when eating with others. There is no pressure to eat these foods right away, but being near these foods and building gradual exposure can be helpful.

Reach out to a Psychologist & Dietitian

Support from a Psychologist and Dietitian with an understanding of ARFID can help you or your loved one learn more about your experiences with food and can collaborate with you on a treatment approach that will suit your needs. Some examples of ways a Psychologist and Dietitian can help include:

Helping to manage feelings of anxiety or stress around mealtimes
Preparing and managing exposure to new or non-preferred foods

Low FODMAP Snack Ideas

Looking for low FODMAP snack ideas?

We hear you.

Starting a low FODMAP diet can feel overwhelming and if we’re honest, it can sometimes feel like you’re trying to decipher a new language when trying navigate what is a high or low FODMAP food.

We often find the biggest stumbling block for clients we work with is figuring out what to snack on.

So look no further, we have compiled our go-to list of low FODMAP snacks to make the journey a little bit easier.

When it comes to building a snack, combining a carbohydrate source with a protein or fat source helps to achieve satisfaction and feelings of fullness.

Some ideas of low FODMAP snacks:

Popcorn & 2 slices of cheddar cheese
- Fun Fact #1: Most types of cheese are naturally low in lactose when consumed in single serve sizes
1 cup of berries & 1 tub of lactose-free yoghurt
1 orange & small handful of almonds, hazelnuts or macadamias
Rice/Corn Cakes & 2 tablespoons ricotta cheese
Gluten Free Grainy Toast with peanut butter & sliced banana
2 Kiwi fruits & Low FODMAP Nut Bar*
- Fun Fact #2: Eating 2 kiwis has been shown to help keep our bowels happy and ease constipation by improving the texture of our bowels and increasing the frequency and regularity of motions.
Boiled eggs with Gluten Free Grainy Toast, drizzle of olive oil and seasoning
Grainy Gluten Free Crackers & 3 tablespoons feta cheese dip
Grainy Gluten Free Crackers & 3 tablespoons eggplant dip
Berry/Banana smoothie with Lactose Free Milk & 1 tablespoon LSA mix
1 cup of grapes & matchbox size brie or camembert & 2 squares of milk chocolate

*Look out for the Monash Low FODMAP symbol on packaged products, such as muesli bars and cereals.

We hope you find these ideas helpful.

Click here for more information on whether a low FODMAP diet is right for you.

It is also important for us to share that the low FODMAP diet has the potential to be particularly restrictive and should not be commenced without consultation from a dietitian that is trained in the area.

3 reasons to enjoy family meals together

With busy lives, varying schedules and the increasing presence of technology in our lives, family meals often move down the priority list.

Family meals may be defined as children and adolescents of all ages, sitting at the table and eating with at least one parent or adult loved one, without technology. It’s not about cooking an elaborate meal or stressing about what your child eats, it is about being together, connecting and learning. These meals do not have to be long either, a main meal may be 20 minutes and a snack may be 10-15 minutes.

Here are three reasons why you may want to consider incorporating family mealtimes into your day.

1. Having regular, sit down meals at the table together helps with establishing a regular meal and snack routine. In doing so, you are helping to support appetite regulation and reduce the chances of mindless grazing between meals, over time.

2. Children and adolescents that eat family meals are more likely to evolve to consume a higher quality diet, according to research. Of note, higher intakes of vegetables, fruits and fibre and lower intakes of saturated fats have been observed (1)

3. Research shows that children and adolescents who eat family meals more often are less likely to experience disordered eating or alcohol and substance use. Research is unclear on the exact mechanism of this relationship. It has been proposed that the perception of family cohesiveness and related increase to self esteem, may reduce the risk of engagement in such unhealthy behaviours (2). Additionally, the experience of positive family mealtime experiences has also been shown to be a protective factor against disordered eating (3).

If you feel you and your family may need some extra guidance in setting up positive family meals, feel free to reach out to our family Dietitian Danielle Bell for support here.

References:

(1) Gillman, M.W., Rifas-Shiman, S.L., Frazier, A.L., Rockett, H.R., Camargo Jr, C.A., Field, A.E., Berkey, C.S. and Colditz, G.A., 2000. Family dinner and diet quality among older children and adolescents. Archives of family medicine, 9(3), p.235

(2) Harrison, M.E., Norris, M.L., Obeid, N., Fu, M., Weinstangel, H. and Sampson, M., 2015. Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. Canadian Family Physician, 61(2), pp.e96-e106.

(3) Neumark-Sztainer, D., Wall, M., Story, M. and Fulkerson, J.A., 2004. Are family meal patterns associated with disordered eating behaviors among adolescents?. Journal of adolescent health, 35(5), pp.350-359.

3 things you can try for your PCOS (without cutting food groups)

3 things you can try for your PCOS (without cutting food groups)

If you, or someone you might know, is living with Polycystic Ovarian Syndrome, you may be familiar with some of the symptoms:

irregular menstrual cycles
fertility issues
weight cycling
insulin resistance
fatigue and inflammation
“hanger”
poor body image
depression
anxiety

Just to name a few.

While unfortunately not all sunshine and daisies, we do have some good evidence to support some small and simple nutrition changes, that are really quite impactful.

And most excitingly, nutrition changes that do not require the cutting of food groups or a strict meal plan. A must here at Glow HQ.

OMEGA 3 Fatty Acids

Helpful for: inflammation, fatigue, ovulation, insulin resistance

Omega 3 fatty acids have been found to support ovulation and to help reduce insulin resistance (6). Their anti-inflammatory powers also mean they help manage the stress your body is trying to cope.

Omega 3 can be found in:

Oily fish e.g. salmon, tuna, sardines, snapper, barramundi, trout
Canola Oil, Olive Oil, Grapeseed Oil, Flaxseed oil
Walnuts, Hazelnuts, Pecans, Pinenuts, Pistachio
Chia Seeds, Linseeds

Supplementation:

Many people living with PCOS may require a therapeutic dose of Omega 3 to support overall health and wellbeing, meaning they may require a supplement. In this case, it is best to speak to your Dietitian about the best dose and brand for you.

INOSITOLS

Helpful for: insulin resistance, carbohydrate metabolism, hanger

Inositols are a form of B-vitamin found in grains, beans and nuts and fruits. They have been found to support how our bodies use insulin, as well as how they metabolise carbohydrate.

While inositols can be naturally found in our diet, best practice recommends a 40:1 ratio of two types of inositol.

Myo-Inositol

D-Chiro Inositol

Speak to your Dietitian about the best ratio and brand for you.

PROTEIN + Protein Timing

Helpful for: inflammation, insulin resistance, “hanger”

You may find that eating slightly more protein each day than other individuals of the same age and size works best for you. While the research is still developing in this area, it seems that having some protein in your meals and snacks can help those with PCOS improve their sensitivity to insulin, help combat inflammatory processes and prevent that all too common” hanger”.

Starting recommendations include aiming for:

>5g protein per snack

>20g at meals

And at least 10-20g at supper

Protein sources include:

Poultry
Red meat
Fish
Eggs
Legumes and lentils
Dairy e.g. yoghurt, cheese, milk
Nuts and nut butters
Protein powders and bars

If you’re looking for more support, reach out to one of our Accredited Practising Dietitians here.

The Low FODMAP diet – please explain

The Low FODMAP diet - please explain

What is the low FODMAP diet? Is it the answer to my gut problems? Find your answers below!

If you have experienced uncomfortable gut symptoms, such as bloating, increased flatulence, abdominal pain or changes in your bowel movements, chances are you have stumbled across the low FODMAP diet. And chances are, you also have a lot of questions.

The low FODMAP diet was developed by Monash University in Australia as a dietary intervention for individuals living with Irritable Bowel Syndrome (IBS). It was designed to be used as a short-term experiment to examine whether or not these FODMAPs may be contributing to your gastrointestinal symptoms. It is not a weight loss diet. It is not a lifetime diet. It is one tool people may use to learn more about their body.

So, what are FODMAPs?

FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are different types of carbohydrates that are fermented (or digested) by a variety of microbes that live in our large intestine.

FODMAPs are found in a range of nutritious foods including certain fruits, vegetables, nuts, dairy, breads and grains. They are generally not absorbed into our bloodstream early in the digestion process like other nutrients from our food, so they end up in our large intestine.

Here they are digested by the variety of microbes, that’s where the “fermentable” comes from. When your microbes ferment these carbohydrates they produce different gases that contribute to bloating. These bodily processes are not unique to individuals living with IBS. However, having IBS may mean you are more vulnerable to experiencing pain when your gut is distended and experience a different pattern of gut movements, which is what can lead to the uncomfortable symptoms.

Is this diet for me?

The low FODMAP diet has the potential to be particularly restrictive and should not be commenced without consultation from a dietitian that is trained in the area.

It can lead to nutritional deficiencies and can make your gut symptoms worse if followed without professional guidance, especially for long periods of time as dietary variety is so important for our gut health. We know that as dietary variety increases, so does the health of our gut bugs!

If you identify with any of the below groups it may be useful to speak with your health care team about non-diet approaches to managing your symptoms:

History of disordered eating/eating disorder
Pregnant
Infants and children
Older aged

The good news is, there are other less intensive dietary interventions that can be explored before attempting the low FODMAP diet. There are also a range of non-diet options, including yoga, meditation, gut-directed hypnotherapy, supplements and medications, which are shown to help with our gut health.

If you would like to learn more about how to develop a self-care plan that is personalised to your symptoms and lifestyle, please reach out to us here so we can connect you with our gut health Dietitian, Danielle.

Please note: Dietitians can’t diagnose gastrointestinal disorders and medical advice should be sought out if you are experiencing any new or changing gastrointestinal symptoms or patterns in bowel movements.

Follow our Instagram @glowgrouphealth for a regular dose of body positive nutrition!

The Power Of Language When Describing People and Their Bodies

Stigmatising language around body weight is one way in which weight stigma shows up in the world. In schools, during interactions with medical and health professionals, at family gatherings and when we are consuming media, to name a few.

Labels such as obese, morbidly obese[1] and weight problem[2] are frequently raised in both research and community circles as phrases that are highly stigmatising and feel like blame statements.[1] There are legitimate reasons for this. Research has shown us that doctors and other health professionals often associate ‘obesity’ with personal attributes such as poor hygiene, reduced will power, dishonesty and reduced intelligence.[3]

Why does the experience of stigma matter? Weight stigma is not just a feeling that exists in isolation. It has real and damaging consequences that can impact one’s experience and access to health.

The literature and experiences of individuals tells us that being a recipient of weight stigma can lead to:

Disordered eating behaviours[4]
Psychological distress, including Anxiety and Depression[4]
Reduced engagement with medical services and health care providers[4]
Social isolation
Avoidance of physical activity[4]
Reduced participation in education amongst children[2]
Increased mortality risk (early death)[5]

Hold on…aren’t these the sorts of health and wellbeing concerns we want to help liberate individuals from?

By pathologising certain body sizes using stigmatising labels, we are making a lot of assumptions. We are assuming disease where disease may not be present. We are assuming that certain bodies are a problem, often without regard for physical, mental and emotional markers of health. We are assuming that body diversity is not acceptable. We are assuming that living in a larger body is a barrier to enjoying health and longevity when we know that this is largely determined by practicing healthy habits, independent of body weight[6].

This of course can be incredibly hurtful and can understandably bring up feelings of anger. It can also lead to what is known as internalised weight stigma, the process of absorbing and believing negative medical and cultural stereotypes associated with labels such as ‘obesity’ and believing those stereotypes to be true of oneself[4].

So how can we step away from contributing to such suffering?

The research suggests descriptors such as weight, higher BMI and fat have been observed to be received as more neutral and less stigmatising in the research. [1][7] However, we should always consider the individual in front of us when we are in a position where we may be asked to describe their body. We need to be considerate of the lived experience and preferences of the individual and appreciate the reasons for which they may find certain weight/shape-related labels stigmatising.

At the end of the day this conversation is ultimately about respect. Individuals in all bodies deserve the right to be described using language that does not feel like it is loaded with a host of assumptions and judgements.

Although this will certainly not eliminate weight stigma, being mindful and reflective about the language we use and share is an important step forward.

References

[1] Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. International journal of obesity. 2013 Apr;37(4):612.

[2] Pont SJ, Puhl R, Cook SR, Slusser W. Stigma experienced by children and adolescents with obesity. Pediatrics. 2017 Dec 1;140(6):e20173034

[3] Puhl RM, Heuer CA. The stigma of Obesity: A Review and Update, Obesity. Rudd Center for Food Policy and Obesity, Yale University. 2009.

[4] World Health Organization. Weight bias and obesity stigma: considerations for the WHO European Region.

[5] Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychological Science. 2015 Nov;26(11):1803-11.

[6] Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. The Journal of the American Board of Family Medicine. 2012 Jan 1;25(1):9-15.

[7] Thomas SL, Hyde J, Karunaratne A, Herbert D, Komesaroff PA. Being ‘fat’in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health expectations. 2008 Dec;11(4):321-30.

Disability Care: A Health at Every Size Approach

Individuals living with a disability in Australia endure health inequalities related to a range of factors, including ineffective healthcare. All individuals deserve access to respectful and inclusive care. Healthcare that considers the complex physical, emotional, social and environmental determinants of wellbeing. Healthcare that caters to the abilities of each individual and supports them to engage in health enhancing-behaviours. This, my friends, describes the Health at Every Size approach.

As Liza wrote about in a previous blog, Health at Every Size (HAES) is a registered trademark of the Association for Size Diversity and Health (ASDAH). ASDAH outlines that the HAES approach is composed of 5 core principles:

Weight inclusivity
Health Enhancement
Respectful Care
Eating for Well-being
Life-Enhancing Movement

You can read more about these principles here.

In working with individuals experiencing physical or intellectual disability, I have come to appreciate how applying these principles can help enhance disability care. In my day-to-day work, some examples include:

Learning about how different food groups/nutrients can affect how our body feels NOT looks.
Working on self-compassion and body respect NOT body manipulation.
Cooking to build capacity and skills and try new foods NOT to cut out enjoyed foods.
Grocery shopping tours to explore food preferences and food literacy NOT to compare calories on packets.
Interactive nutrition games to promote behaviours such as hydrating when playing sports or eating a varied diet to help with concentration NOT to elevate weight loss as a goal.
Education on weight science and the multitude of factors with disability that can lead to weight changes, such as medications and hormonal adaptations NOT placing blame and responsibility on the individual.
Communication with staff, other health professionals and family to reduce weight bias in practice and language NOT to reinforce stigmatising language and harmful weight-based goals.
Flexible meal and snack guides NOT prescriptive meal plans.
Understanding of disability and related eating behaviours NOT assumptions based on weight and size.
Acknowledging the social, emotional and physical significance of food NOT removing ‘bad foods’ without regard for overall quality of life.
Brainstorming enjoyable movement and community participation NOT forced physical activity.

People living with a disability experience enough adversity in their life. That is why I think it is paramount that I help lift the heavy burden of restrictive diets off their shoulders. HAES helps make this possible by centering self-care, acceptance and empowerment, regardless of size or ability.

What is the Non-Diet approach?

The non-diet approach is a way of delivering medical nutrition therapy that focuses on optimising health behaviours. It rejects the notion that the pursuit of weight loss/body shape or size manipulation is the key to health. In fact, it acknowledges the damage that dieting for weight loss can do to our health and our relationship with food. Any of these side effects of dieting sound familiar to you?

Weight cycling
Food rules
Inability to respond to hunger and fullness
Restrict-over eat cycles
Feeling guilty after eating certain foods/portions
Lack of dietary variety
Avoidance of carbohydrates/sugars/fat…
Fear of weight change
Stress when making food choices

On the surface, dieting with the intent of changing your body may seem like a harmless idea, maybe even health-promoting one. That is understandable considering we are swimming in a weight-centric wellness culture that elevates thinness. Often this occurs without deeper consideration for a) if weight loss is really necessary to improve the health and quality of life of the individual and b) what striving for thinness could really do to a person’s health.

Now, you may be thinking, how can a Dietitian help me without putting me on a diet?

Good question.

A non-diet Dietitian may help you work on:

Connecting to and embracing your physiological hunger and fullness signals
Body trust
Achieving a diverse and flexible dietary pattern
Breaking down black and white thinking about food
Appreciating the natural variation in human body shapes and sizes
Understanding weight science and the risks associated with diets
Engagement in movement that feels enjoyable and sustainable
Developing self-compassion to promote self-care
Building food knowledge and a skillset around meal building

Importantly, this approach aims to help you get curious about your own body. When you think about it, diets, also known as restrictive meal plans/kilojoule counting/macro tracking/lifestyle (*cough, cough* weight loss) programs (I could go on!) assume that you do not have the ability to nourish yourself. They assume you need external rules and people telling you how to eat in order to find health. They tell you that there is no place for experimenting with food and no place for listening to your body.

This is simply not true. The non-diet approach helps you reclaim your body autonomy. It gives you the tools to navigate your own personal nutrition and wellbeing journey. You have the wisdom within you, the non-diet Dietitian is here to help you illuminate it.